Uveitis and glaucoma: a look at present day surgical options

Abstract

Purpose of reviewTo review the various surgical options of management of medically refractory glaucoma in uveitic eyes.Recent findingsUveitic glaucoma is particularly challenging to manage. We look at the evidence for various surgical options, or the lack of, in the surgical management of medically refractory glaucoma in uveitis.SummaryConventional glaucoma filtration surgeries such as trabeculectomy and glaucoma drainage implants were more commonly described first line surgical options in the therapy of medically refractory uveitic glaucoma. However, with the introduction of newer implants and options of minimally invasive glaucoma surgeries, the choice of first line surgeries may now be possibly expanded to include other options. However, more research is required to evaluate the efficacy of the newer surgical options in the management of glaucoma in uveitis patients.

A Rare Case of Postoperative Uveitis and Obstructive Peripheral Anterior Synechiae Following Combined OMNI Canaloplasty and Hydrus Microstent Implantation

“…This approach, however, is not without its complications and can often result in hypotony. 10 Current research is deficient in its exploration of the utilization of the Hydrus microstent and OMNI canaloplasty in the context of uveitic glaucoma. Yet, some experts in the field, such as Seow et al, 10 have hinted at the potential of the Hydrus device as either a primary or secondary conjunctiva-sparing surgery for uveitic glaucoma patients.…”

“… 10 Current research is deficient in its exploration of the utilization of the Hydrus microstent and OMNI canaloplasty in the context of uveitic glaucoma. Yet, some experts in the field, such as Seow et al, 10 have hinted at the potential of the Hydrus device as either a primary or secondary conjunctiva-sparing surgery for uveitic glaucoma patients. The pioneering work of Haas with trabeculodialysis and the subsequent adoption of the Barkan goniotomy, particularly among children with conditions like juvenile rheumatic arthritis (JRA), underscores the promise of angle-based surgeries.…”

Update on Diagnosis and Treatment of Uveitic Glaucoma

“…Sotani et al performed microhook trabeculotomy with a straight Tanito microhook (M-2215 s, Inami & Co., Ltd., Tokyo, Japan) in 36 eyes of 30 patients and reported that after 1 year, surgical success was achieved in 67% of eyes [ 84 ]. Other MIGS used are the i-stent and Hydrous, which might have a role as primary or secondary conjunctival sparing procedures in UG [ 85 ].…”

“…These situations are not well described in literature and a leap of faith may be required. There is no unanimity regarding the best surgical approach, and trabeculectomy, tubes or even MIGS may be tried depending on the clinical picture and the preference of the surgeon [ 85 ].…”